POMS Reference

This change was made on Dec 5, 2017. See latest version.
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DI 22501.001: Disability Case Development for Evidence

changes
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  • Effective Dates: 03/02/2016 - Present
  • Effective Dates: 12/05/2017 - Present
  • TN 23 (11-12)
  • TN 27 (12-17)
  • DI 22501.001 Disability Case Development for Medical and Other Evidence
  • DI 22501.001 Disability Case Development for Evidence
  • Citations:
  • Social Security Act - Sections 223(d), 1614(a), 1631(e)
  • Regulations - 20 CFR sections 404.1512 through 404.1516, 404.1520, 416.912 through 416.916, and 416.920
  • Regulations - 20 CFR sections 404.1512 through 404.1516, 404.1520, 404.1520b, 416.912 through 416.916, 416.920, and 416.920b
  • A. Purpose of case development
  • We develop medical and other evidence to establish:
  • We develop evidence from medical and nonmedical sources to establish:
  • * whether the claimant is disabled or blind,
  • and as needed,
  • * the date disability began, and
  • * the date disability ended.
  • * the date disability ended, if applicable.
  • B. Definition of evidence
  • Evidence is any medical or non-medical information the claimant or anyone else submits, or we obtain, that relates to the disability claim.
  • Evidence is anything the claimant or anyone else submits to us, or that we obtain, that relates to the claim for disability benefits.
  • For the categories of evidence, see DI 24503.005B.
  • At each level of adjudication, evidence may include, but is not limited to:
  • * Objective medical evidence:
  • * medical signs, and
  • * laboratory findings.
  • * Narrative medical records from medical sources:
  • * medical history, and
  • * treatment records.
  • * Medical source opinions and statements, including those from:
  • * state agency and regional medical consultants (MC) or psychological consultants (PC) and other program health care professionals, and
  • * consultative examination (CE) sources.
  • * Statements from the claimant or others about the claimant’s:
  • * impairment(s),
  • * restrictions,
  • * daily activities, and
  • * efforts to work.
  • * Any relevant statements the claimant makes:
  • * to medical sources, during the course of examination or treatment, or
  • * to the field office (FO) or Disability Determination Services (DDS), during face-to-face or telephone interviews, on applications or other forms such as function reports or work history, in letters, and in testimony during an administrative hearing.
  • * Information from other sources, including:
  • * educational personnel,
  • * social welfare agency personnel, and
  • * other medical and non-medical sources. For examples of medical sources and non-medical sources, see DI 22505.003B.3.
  • * Decisions by any government or non-government agency about whether the claimant is disabled or blind.
  • * A report of investigation (ROI) prepared by the Office of the Inspector General or Cooperative Disability Investigations Unit; see DI 23025.020A.2.
  • For details on what is not considered evidence, see DI 24503.001B.
  • C. Evidence we consider for a disability determination
  • We consider all relevant evidence in the case folder when making a disability determination. This includes relevant evidence we:
  • * have in our records, including relevant evidence from available prior folders,
  • * receive from the claimant, and
  • * develop from medical and other sources.
  • For a definition of relevant evidence, see DI 20503.001B.2.
  • D. Completeness of medical and non-medical evidence
  • Case evidence must be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind. The evidence must allow adjudicator(s) to determine:
  • * the nature and limiting effects of the claimant’s impairment(s),
  • * whether the 12-month duration requirement is met or is expected to be met,
  • * the claimant’s residual functional capacity (RFC) to do work-related physical and mental activities at Steps 4 and 5 of sequential evaluation, and
  • * the established onset date (EOD).
  • We consider all relevant evidence in the case record when making a disability determination. This includes the following evidence we have:
  • * in our records, including relevant evidence from available prior folders,
  • * received from medical sources, and
  • * received from nonmedical sources, including the claimant.
  • NOTE: When the adjudicator considers evidence from a prior folder(s), the evidence from the prior folder(s) must be included in the current case folder.
  • For the definition of relevant evidence, see DI 24515.001B.2.
  • D. Completeness of medical and other evidence
  • The evidence we receive must be complete and detailed enough to permit an independent determination about whether the claimant is disabled or blind.
  • Therefore, the evidence must allow the adjudicator(s) to determine:
  • * the nature and severity of the claimant’s impairment(s),
  • * whether the 12-month duration requirement is met,
  • * the claimant’s residual functional capacity when steps 4 and 5 of sequential evaluation apply, and
  • * the established onset date, if applicable.
  • When there is enough evidence, the adjudicator should be able to understand how the claimant functions on a day-to-day basis.
  • When there is enough evidence, the adjudicator should be able to picture how the claimant functions on a day-to-day basis.
  • NOTE: The adjudicator may discontinue development when the evidence is consistent and sufficient to make a fully favorable determination. For details, see Expedients to Evaluate and Develop Evidence for Potential Mental and Physical Impairments in section DI 24505.030.